Cardio Flashcards
Causes of heart failure
Ischaemia
HTN
alcohol
symptoms of HF
SOB
ankle swelling
fatigue
investigations in suspected heart failure
Echo: ejection fraction reduced
BNP: increased
How would you manage a patient with HF?
lifestyle
Symptoms: diuretics, loop or potassium sparing
1st: ACEI and BB
2nd: ARB
What are the catagories in CHADSVASc
CHF
HTN
Age>75
Db
Stroke/TIA
Vascular disease
Age 65-74
Sex: Female
Management of stable angina?
GTN
BB: bisoprolol
CCB (verapamil if instead of BB, amlodipine if + BB)
Aspirin
Long acting nitrate
Ivabradine
Ranolazine
Statin
Systolic murmurs
Ejection: AS
Pan: MR, innocent flow murmur
late: Mitral prolapse
continuous machine: PDA
*associated with Turners*
early diastolic mumur
AR
pansystolic mumur
MR
VSD
Mid-late diastolic murmur
MS
AS murmur
Ejection systolic, radiates to carotids
AR murmur
early diastolic
collapsing pulse
head bobbing
blowing
MR murmur?
pansystolic at apex, radiates to axilla
Blowing
MS murmru
mid late diastolic best heard left lateral positions
laterally displaced apex
Machine like murmur?
PDA
Features of PDA OE
L->R shunt (breathless)
left subclavicular thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
Describe 1st degree heart block ECG
increased PR interval
Describe 2nd degree heart block ECG
Mobitz 1: increasing PR then dropped QRS
Mobitz II: increased PR then dropped QRS
Describe 3rd degree heart block ECG
no relation between P and QRS
When do you cardivert?
onset within 48 hours
hypotensive
what is wolff parkinson white syndrome?
ventricular pre-excitation syndrome associated with paroxysmal tachy
what causes WPWS?
congential abnormality - accessory pathway connecting atria and ventricles
What does an ECG look like in a pt with WPWS?
slurred QRS start
How do you manage WPWS?
1st: radiofrequency ablation
2nd: amiodarone, sotalol
which medication is absolutely contraindicated in WPSP?
Digoxin
How does pericarditis present?
acute chest pain
worst on inspiration, better when leaning forward
radiates to neck and shoulders
dyspnoea and cough
rash, joint pain, fever, weight loss
sound OE of acute pericarditis?
pericardial rub
ECG findings in pericaritis?
ST elevation, saddle shaped ST, PR depression
How do you manage acute pericarditis?
NSAIDS
colchicine after 14 days no imporvement
steroids if still no improvement
causes of pericarditis?
viral: coxsackie b, echo, HIV
autoimmune: sjorens, RA, SLE
tetralogy of falot
1) pulm stenosis
2) RV outflow obstruction
3) overriding aorta
4) ventricular septal defect
how do you manage transposition of the great arteries?
IV prostaglandins
atrial septostomy
arterial switch
what causes infective endocarditis?
Rheumatic heart disease
valvular disease
prosthetic valve
IVDU
How does sub acute infective endocarditis present?
- Janeway lesions
- Oslers nodes
- Purpura
- fever
Acute infective endocarditis presentation?
- splinter haemorrhages
- petechiae
- night sweats
- rigor
*if new murmur and fever = IE until proven otherwise
causative organisms of infective endocarditis?
staph aureus
staph epidermis
*gram +ve cocci*
how do you investigate infective endocarditis?
DUKES CRITERIA
echo: larger vegetations
microbiol: 3 samples in 24h,( first before Abx , diff sites, diff times)
How do you manage infective endocarditis?
actute: fluclox, gent
sub acute: benpen, gent
prosethic/resistant: genta, rifampicin
surgery: valve replacement
Which cardiac rhythms are non-shockable
Pulseless electrical activity and asystole
in which patients are nitrates CI?
hypotensive
